OBJECTIVETo study surgical outcomes of medial plus anterolateral approaches for the treatment of tibial plateau fractures involving three columns.

METHODSFrom March 2010 to March 2012,20 patients with tibial plateau fractures involving three columns were treated with internal fixation by using T-shape, L-shape plate, or distal radius T-plate through medial plus anterolateral approaches. Among the patients, 13 patietns were male and 7 patients were female,ranging in age from 29 to 52 years old with an average of 39.4 years old. The intervals between injury and operation ranged from 8 to 12 days, with a mean of 9 days. At the latest follow-up,the American Hospital for Special Surgery score (HSS) was used to evaluate clinical effect,and the average loateau angle,posterior slope angle and femorotibial angle of tibia were measured on the X-ray films.

RESULTSThe average operation time was 2.11 hours; average intraoperative blood loss was 452 ml and average hospital stay was 22.3 days. All the patients were followed up,and the duration ranged from 12 to 20 months,averaged 14.6 months. The fracture healing time ranged from 3 to 8 months, with a mean of 6.1 months. The average loateau angle, posterior slope angle and femorotibial angle of tibia at 3 days after operation were (86.1 +/- 2.7) degrees, (10.7 +/- 1.6) degrees and (168.0 +/- 4.7) degrees respectively; and (84.1 +/- 3.2) degrees, (13.7 +/- 1.9) degrees, (170.0 +/- 5.8) degrees respectively at 1 year after operation (P > 0.05). According to HSS, 11 patietns got an excellent result, 6 good, 2 poor and 1 bad. There were no postoperaive neural and vascular injuries, no plate lossening or broken. One patient had local infection. One patient had skin flap partial necrosis and was cured by conservative treatment. Four patients had postoperative numbness below the inside leg.

CONCLUSIONMedial plus anterolateral approaches for the treatment of fractures involving three columns are effective to get good anatomic reduction and stable fixation without changing body position, which is helpful to early functional rehabilition of knee joint.